Form Rpd-41279 - New Mexico Job Mentorship Tax Credit Certificate Request Form printable pdf download

RPD-41279

STATE OF NEW MEXICO - TAXATION AND REVENUE DEPARTMENT

Rev. 10/22/2014

Job Mentorship Tax Credit Certificate Request Form

Purpose of this form.

An accredited New Mexico secondary school sponsoring a school-sanctioned career preparation

education program may use this form to request Job Mentorship Tax Credit Certificates (Form RPD-41281) from the Depart-

ment. The principal of an eligible school must submit a completed Form RPD-41279 to a local district tax office to obtain

the certificates. The Department may issue a maximum number of certificates equal to the number of qualified students in

the school-sanctioned career preparation education program on October 15 of that school year, as certified by the school

principal. See the definitions below. For assistance call (505) 827-0792.

Name of New Mexico accredited secondary school

Mailing address

City, state and ZIP code

Contact name

Telephone number

E-mail address

Definitions

Career Preparation Education Program means a work-based learning or school-to-career program designed for second-

ary school students to create academic and career goals and objectives and find employment in a job meeting those goals

and objectives.

Qualified Student means an individual who is at least 14 years old but not more than 21 years old who is attending an

accredited New Mexico secondary school full time and who is a participant in a career preparation education program sanc-

tioned by the secondary school.

The principal of the New Mexico accredited school must complete this form.

1. Enter the beginning and ending dates of the school year for which Job

From

through

Mentorship Tax Credit certificates are requested. A separate request

form must be submitted for each school year.

2. Enter the number of certificates requested.

The number of certificates requested in a school year by a qualifying

school cannot exceed the number of qualified students participating

in the school-sanctioned career preparation education program on

October 15 of the applicable school year.

Certifications. (You must check the applicable boxes)

I certify that the school named above:

is an accredited New Mexico secondary school,

participates in a school-sanctioned career preparation education program, and

that the number of certificates requested does not exceed the number of qualified students participating in the

career preparation education program sanctioned by this school on October 15th of the school year indicated

above.

Signature of the school principal

Date

Form Rpd-41279 - New Mexico Job Mentorship Tax Credit Certificate Request Form